MEDICARE: PRIME WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1427938869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME WELLNESS LLC

Provider Business Mailing Address
First Line	:	3941 PARK DR
Second Line	:	STE, 20-118
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4549
Country	:	US
Telephone Number	:	469-854-3546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4697 GOLDEN FOOTHILL PKWY
Second Line	:	STE, 106
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762
Country	:	US
Telephone Number	:	469-854-3546
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER / OWNER
Name	:	TUHIN CHAUDHURY
Credential	:	MD
Telephone Number	:	469-854-3546

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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